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   Table of Contents - Current issue
Coverpage
May-August 2018
Volume 7 | Issue 2
Page Nos. 75-141

Online since Monday, October 1, 2018

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ORIGINAL ARTICLES  

Double contact lens-assisted corneal cross-linking in ultrathin corneas with keratoconus p. 75
Abdulrahman M Alamri
DOI:10.4103/sjhs.sjhs_18_18  
Aims: This study aimed to evaluate the safety and effectiveness of double contact lens-assisted corneal cross-linking (CXL) in keratoconus patients with very thin corneas. Settings and Design: This is a prospective, interventional, nonrandomized, and noncontrolled case series. Subjects and Methods: Twenty eyes of 15 patients with the corneal thinnest point (CTP) <400 μm were included in the study. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), Scheimpflug imaging, and endothelial cell loss were evaluated at baseline and at each study visit. After corneal epithelial debridement, ultrasonic pachymetry was used to measure CTP. Double soft contact lenses were applied while riboflavin was instilled every 2 min and ultrasonic pachymetry was repeated. The cornea was then exposed to ultraviolet A light (370 nm, 3 mW/cm2) for 30 min. Riboflavin 0.1% was administered every 2 min during irradiation. Statistical Analysis Used: Statistical evaluation of values at baseline and 6- and 12-month after CXL was performed using t-test with SPSS software version 20 (SPSS Inc., Chicago, IL, USA). Results: Following epithelial removal, mean CTP was 271.4 ± 13.7 μm (range: 263–284 μm). After double contact lens placement, mean CTP increased by 196.8 ± 15.4 μm (range: 188–223 μm) for a mean thickness of 467.1 ± 19.4 μm (range: 423–508 μm). No statistically significant differences were observed in maximum keratometry value (Kmax) and posterior elevation 1 year after CXL. Endothelial cell count, CDVA, anterior elevation, and average of simulated keratometry values (Average SimK) as well as the CTP were not significantly different before and 12 months after CXL. No postoperative complications were encountered in any of our patients. Conclusion: Double contact lens-assisted CXL can be effective for stabilizing corneal topography in eyes with advanced keratoconus, including those with corneas that are too thin for traditional CXL. Further controlled studies with a larger sample size are recommended to confirm our findings.
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Total antioxidant status in sickle cell anemia p. 80
Tolulase Aderayo Olutogun, Kehinde Joyce Olufemi-Aworinde, Foluke A Fasola, Gbemi Henry Ano-Edward, Olufemi Opeyemi Aworinde, Anthony O Ajiboye
DOI:10.4103/sjhs.sjhs_34_18  
Background: The homozygous sickle cell anemia (SCA) has an unstable hemoglobin (HbS). The heme group dissociates easily from globin chain and the iron is released and free within the red cell. In addition, the sickle red cells release cell-free hemoglobin after undergoing intravascular hemolysis. These contribute to increased reactive oxygen species and oxidative stress ensues. Oxidative stress contributes to complications such as acute chest syndrome and pulmonary hypertension both of which are severe manifestations of SCA. Objectives: In this study, we set out to correlate inflammatory markers of disease severity with oxidative stress. Materials and Methods: We compared the total antioxidant status of 61 steady-state SCA patients with 60 HbAA controls. We then investigated associations between the total antioxidant levels and hematological and clinical indices of the patients in order to establish a relationship between markers of oxidative stress and markers of sickle cell severity. Results: We found that that total antioxidants were significantly lower in SCA compared with control levels (50% lower). The total antioxidants levels were inversely proportional to leukocyte and especially neutrophil cell counts which are pro-inflammatory markers. Conclusion: Oxidative stress which leads to secondary complications correlates with pro-inflammatory markers of clinical severity in SCA.
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Role of the work-to-rest ratio in high-intensity interval exercise on heart rate variability and blood pressure in sedentary obese men p. 83
Abdullah F Al-Fehaid, Shaea A Alkahtani, Ahmed A Al-Sunni, Talay Yar
DOI:10.4103/sjhs.sjhs_103_17  
Objective: The effect of different durations of high-intensity interval exercise (HIIE) on heart rate (HR) variability (HRV) and blood pressure (BP) in obese men. Materials and Methods: The study was a repeated measure and conducted in a counterbalanced order. Fifteen young obese men participated in five exercise tests on a cycle ergometer as follows: (a) graded exercise test to determine exercise intensity, (b) constant-load exercise test at 40% of HR reserve (HRR) for 20 min, (c) the 30:30 HIIE protocol at 80% of HRR (30 s of exercise followed by 30-s recovery intervals for 20 min), (d) the 60:60 HIIE protocol at 80% of HRR for 20 min, and (e) the 60:30 HIIE protocol at 80% of HRR for 15 min. HRV and BP were recorded before exercise, at the end of exercise, and at 30 min after exercise. Participants also provided feedback regarding the pleasure and excitement to exercise. Results: HRV recovery was greater in the 30:30 HIIE protocol and lesser in the 60:30 HIIE protocol. The mean arterial BP exhibited postexercise hypotension. Peak rate pressure product during exercise was highest in the 60:30 protocol and lowest in the 30:30 protocol. The participants preferred the 60:60 HIIE protocol in terms of pleasure and excitement. Conclusions: Interval exercise of 1:1 ratio model is recommended over the 2:1 ratio for obese men, with better physiological responses to the 30:30 HIIE protocol and better psychological responses to the 60:60 HIIE protocol.
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Screening mammography and breast self-examination: Attitudes and practices of women in the Eastern Province of Saudi Arabia p. 89
Fatima AL-Mulhim, Radwa Bakr, Dana Almedallah, Nourah Alkaltham, Abdullah Alotaibi, Saud Alnoaim
DOI:10.4103/sjhs.sjhs_4_18  
Background: The Eastern Province has the highest incidence of breast cancer in Saudi Arabia. The absence of an organized national education and screening program, combined with sociocultural factors, contributes to the presentation of advanced stages. Aim: This study was undertaken to assess the attitudes and practices of women in the Eastern Province toward screening mammography (SM) and breast self-examination (BSE). Subjects and Methods: A cross-sectional study was carried out using a structured questionnaire. Statistical Analysis: We used the Statistical Package for the Social Sciences. Double data entry procedures were used to assure quality and to detect errors in data entry. Frequency distributions were used to describe the data. Association between variables was evaluated by the Chi-square test, and a P≤ 0.05 was considered indicative of statistical significance. Results: A total of 611 females responded to the questionnaire. 12.4% reported having undergone mammography, 48.1% reported that they intended to do it in the future, while 12.7% reported having no intention to perform it. 43% reported performing BSE regularly. Sources of information about breast cancer and breast cancer screening included educational campaigns (27.8%) and media (27.8%). 75.2% of the respondents reported that their physician had no role in educating them about breast cancer screening. There was a significant relationship between the educational level of respondents and the practice of both BSE (P = 0.0001) and SM (P = 0.0000), as well as a significant association between the practice of mammography and having a relative diagnosed with cancer (P = 0.001). Conclusion: The results of our study revealed a low prevalence of breast cancer screening behaviors, 43% reported performing BSE, and only 12.4% had previously undergone SM. We strongly recommend that efforts must be carried out to increase the awareness of women.
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Oscillometric blood pressure profile and anthropometric indices among healthy school children in ilorin, North-central Nigeria p. 101
Olayinka Rasheed Ibrahim, Olanrewaju Timothy Adedoyin, Ayodele Ojuawo, Joseph K Afolabi, Olugbenga A Mokuolu, Mohammed B Abdulkadir
DOI:10.4103/sjhs.sjhs_59_18  
Context: Oscillometric devices are preferred method for measuring blood pressure (BP) among children. Aims: This study measured BP among school-age children using a validated oscillometric device (Omron 705 IT®) and correlated the findings with the anthropometric parameters, with a view to determine the predictors of BP. Settings and Design: This was a cross-sectional, descriptive study. A multistage stratified random sampling technique was used in the selection of pupils from primary schools in Ilorin, Nigeria. Subjects and Methods: Two serial BPs were measured used using Omron 705 IT® with appropriate cuffs using “the fourth report” guideline and standard methods were used for measurement of anthropometrics. Statistical Analysis Used: Data were analyzed using SPSS version 20. Results: A total of 1745 primary school-aged children comprising of 873 males and 872 females were recruited. Anthropometric parameters were comparable between males and females. Mean systolic and diastolic BPs were 103.8 ± 11.0 mmHg and 61.3 ± 8.4 mmHg, respectively. Mean systolic BP was lower in males compared with females (102.9 ± 10.6 mmHg vs. 104.7 ± 11.3 mmHg, respectively,P= 0.001). Mean diastolic BP in males was lower compared with females (60.7 ± 8.3 mmHg vs. 61.8 ± 8.5 mmHg, P= 0.009). Most of the anthropometric parameters correlated with the BPs. Independent predictor of BP was weight, height, and body mass index (BMI), P < 0.001. Conclusions: There was a weak correlation between the oscillometric BPs and anthropometric parameters with weight, height, and BMI been the independent predictors of BP.
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Perception of students and teachers about didactic teaching: A cross-sectional study p. 107
Raid Saleem Albaradie
DOI:10.4103/sjhs.sjhs_28_18  
Context: Didactic (lecture) method is a popular way of delivering the information in class among teachers amidst the other multiple novel methods, but there are very few researches published related to exploring the perception of teachers and students about effective didactic teaching. Aims: The aim of this survey is to find the best way to deliver a lecture as per the opinion of students and teachers in the College of Applied Health Sciences. Settings and Design: A cross-sectional survey through a questionnaire was obtained from a previous study on medical students with original questionnaire consisting of 17 items. In addition to the 17 items in the questionnaire, 4 new items were included through a pilot study on students and teachers in the College of Applied Medical Sciences. Subjects and Methods: Students (n = 110) and teachers (n = 41) participated in the cross-sectional study. Good Teaching Questionnaire was used to obtain opinion and views about ways to make didactic teaching better and effective. Statistical Analysis Used: Nonparametric tests were used to analyze data obtained from the questionnaire. Results: Almost 100% of teachers and students agreed to include mental rehearsal and smart board method of teaching in didactic method. Nearly 100% of students and 29.2% (12) of teachers agreed to include multiple-choice questions in the lecture. Conclusions: Smart board presentation is preferred over the other modes of delivery of information. Mental rehearsal at the end of class is a useful tool to enhance learning and content retention. Teachers must implement students' suggestions such as ideal duration of class, time of class, lot of relevant examples, and little bit of fun would make learning enjoyable and effective.
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Social media in healthcare: Advantages and challenges perceived by patients at a teaching hospital in eastern province, Saudi Arabia p. 116
Mona Faisal Al-Qahtani, Alaa Khalid Alsaffar, Abrar Radhi Alshammasi, Ghufran Sadeq Alsanni, Zahra Tawfeq Alyousef, Mishael Fahad Alhussaini
DOI:10.4103/sjhs.sjhs_36_18  
Aims: This study aimed to determine the types of, the frequency of, and reasons for social media usage by patients. In addition, this study attempts to explore patients' perceptions of the advantages and main challenges associated with using social media in healthcare. Subjects and Methods: This was a cross-sectional study. Questionnaires were distributed to a convenience sample of 400 patients at a teaching hospital in Eastern Province, Saudi Arabia. The data were analyzed by performing descriptive and inferential statistics. Results: Of the 400 patients, 377 patients used social media. Females were more frequent users (60.7%) of social media than males (39.3%). Young patients were more frequent users of social media than older patients. Most patients used social media daily. The patients reported that the main purpose of their usage of social media was to care for their own health. The main advantage was to enable patients to learn about the symptoms of their illness and the method of treatment. A small percentage of patients believed that using social media in healthcare might breach the confidentiality and security of their information, which was the main challenge associated with using social media in healthcare. Conclusion: Social media is revolutionizing healthcare delivery, and its benefits overcome its drawbacks.
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Patterns and knowledge of contraceptive methods use among women living in Jeddah, Saudi Arabia p. 121
Faisal Alhusain, Fahad Alkaabba, Nada Alhassan, Shams Alotaibi, Sarah Breakeit, Emad Musaudi, Ahmed Alhasan
DOI:10.4103/sjhs.sjhs_8_18  
Objectives: Birth control or contraception has become a fundamental part of women's healthcare. Multiple studies have been conducted to determine women's knowledge of contraception. This study aimed to know the patterns of contraception use and to assess the knowledge of contraceptive methods among women living in Jeddah, Saudi Arabia. Methods: A cross-sectional previously validated survey was carried out between June and December 2016 among female Saudi citizens aged 18 years or older and living in Jeddah City, Saudi Arabia. In total, 979 female participants responded to the questionnaire. Results: The prevalence of contraceptive use among Saudi women living in Jeddah was 67.7%. Preventing pregnancy was the most frequent reason for using contraception (69.7%). Oral contraceptives were the most commonly used contraceptive type used (31.8%) followed by intrauterine devices (21%). Almost 16.4% used the withdrawal method, and the male condom method was used by 13.6%. Mood swings and depression were the most common side-effects encountered (34.6%). Furthermore, primary educated individuals reported significantly less contraceptive use compared to individuals who had a high level of education by 47% (odds ratio = 0.53, 95% confidence interval = 0.3–0.95). Age, years of marriage, and number of children were not shown to have any significant effects on contraception use among the participants. Conclusions: The study showed knowledge gaps in the use of different contraception methods. The most common contraceptive methods among Saudi women in Jeddah are pills and intrauterine device. Education played a big role to use the different type of contraception. Effective strategies should be implemented to raise awareness of the appropriate use of contraceptives and dispel misconceptions.
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Factors associated with postnatally maternal-infant attachment in taif, Saudi Arabia p. 127
Salwa Ibrahim Abbas, Maryam Hassan Turkistani, Abrar Abdullah Al-Gamdi, Samer Abdullah Alzahrani, Abdulrahman Ahmad Alzahrani, Farihan Farouk Helmy
DOI:10.4103/sjhs.sjhs_50_18  
Background: The attachment is an important aspect of the relationship between mother and infant. However, besides mother, the other influential factors, including social and cultural environments, play a key role in the level of attachment to their infants. Therefore, the regional studies are needed to assess the impact of factors affecting attachment postpartum period. In this study, we investigated the effect of factors on mother–infant attachments in Taif city, Saudi Arabia. Methodology: The survey was carried out among 200 women 1–2 months postnatal, who were attending healthcare center in the middle of the city and were living in Taif city, Saudi Arabia. It was held during the period from January to March 2018. The survey was used to acquire sociodemographic data, reproductive history, and mother–infant attachment scale. Results: Out of 200 women, 172 (86%), 20 (10%), and 8 (4%) mothers showed positive, negative, and unclear attachments, respectively. Positive attachment was high among educated (90.6%) and employed (85.2%) mothers (P = 0.001). Furthermore, high gravidity and parity promote positive attachments. The positive attachment was more inclined toward girl child (95.7%), while the other factors including social support, being a full-term baby, breastfeeding, pregnancy planning, and history of abortion showed no significant effect on attachment. Conclusion: The psychological status of the mother is one of the governing factors which affect bonding during pregnancy and postpartum. Extensive care should be provided to pregnant women with high number of pregnancies especially if they are of lower level of education to help them avoid negative attachment with their infants.
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Pregnancy-related health behavior of Saudi women and key information sources: A clinic-based study p. 132
Suhasini Ramisetty-Mikler, Sara Javed, Saja S Alamri, Sabreen Kalantan, Wesam Ibrahim Yousef Kurdi
DOI:10.4103/sjhs.sjhs_15_18  
Background: Topics concerning preconception, prenatal health, and prenatal care-seeking behavior among Arab women have not been sufficiently addressed. This study focuses on these behaviors in Saudi pregnant women as they relate to birth outcomes. Aims: The aim of the study was to characterize preconception and prenatal health behavior concerning nutrition and physical activity and to identify health information sources that may impact their health literacy. Methods: A sample of 258 pregnant Saudi women recruited from two major hospital clinics in Riyadh were interviewed. Factors affecting folic acid (FA) awareness and consumption were examined individually using logistic regression to generate crude odds ratio (OR) and adjusted OR (AOR). Results: An overwhelming majority (>90%) is aware of significance of FA, however, less than half took supplements preconceptionally or consumed foods rich in FA. Younger (<30 years) women (AOR = 0.43; 95% confidence interval [CI] = 0.19, 0.98; P < 0.05) and women with lower education level (AOR = 0.36; 95% CI = 0.15, 0.89; P < 0.05) are less likely to have heard or known about the role of FA in preventing birth defects (AOR = 0.45; 95% CI = 0.23, 0.88; P < 0.05) and less likely to have knowledge of foods rich in FA (AOR = 0.57; 95% CI = 0.32, 1.0; P < 0.05) compared to college-educated women. Conclusion: The results suggest that awareness of folate importance is high, however, the consumption or supplementation of folate is low. The study findings highlight the need for routine preventative health care and educational opportunities for couples. In particular, younger women and women with lower educational level should be targeted for interventions.
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CASE REPORT Top

Sliding hernia uterus inguinale in a child p. 138
Rahul Gupta
DOI:10.4103/sjhs.sjhs_46_18  
Uterine adnexa may be the content of the inguinal hernial sac in up to one-fifth of the pediatric female patients. Inguinal hernia containing uterus is known as “hernia uterus inguinale” which is a very rare condition. We report sliding inguinal hernia containing uterus and uterine adnexa in a 2-year-old girl who presented with 3.5 cm × 2.5 cm, partially reducible swelling in the left inguinal region extending to the upper part of the left labia majora. Uterus and ipsilateral fallopian tube with ovary were meticulously dissected from the hernial sac till the margins were free for closure of the sac. The contents were reduced en mass, and high ligation of the hernial sac with plication of deep ring was performed. Close follow-up and gynecological evaluation during the childbearing age are recommended.
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LETTER TO EDITOR Top

Mastoid osteoma: Report of a case and literature review p. 141
Mahmood Dhahir Al-Mendalawi
DOI:10.4103/sjhs.sjhs_22_18  
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